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February 7, 2009

Diagnosis and Symptoms, Type 2 in Youth

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Question from Monticello, Indiana, USA:

I have a strong family history of diabetes and pancreatic cancer. Recently, my 10-year-old son started showing possible signs of diabetes, including increased hunger, thirst, frequent urination, feeling tired, and nausea/vomiting. He has gained almost 30 pounds in the last six months. At first, his doctor told me I was overly concerned. I have a meter at home and began checking him over the past weekend and found he’s in the high 120s mg/dl [6.7 to 7.0 mmol/L] to low 130s mg/dl [7.2 to 7.3 mmol/L] when getting up in the morning, before breakfast. I have been checking as soon as he gets home from school, before snacks, and he’s been in the 130s mg/dl [7.3 to 7.4 mmol/L]. About two hours after dinner he’s in the 160s mg/dl [8.9 to 9.4 mmol/L]. Is this too high? What are the normal ranges I should be looking for to be ideal? I have made him another appointment with the family doctor for today after school, but I’m worried his doctor will tell me I’m overreacting again! My son has already missed several days of school this year and even been sent home at least twice because he begins vomiting. Within 12 hours or so, he’s mysteriously fine again.

Answer:

From: DTeam Staff

You didn’t indicate how much your child weighs, but 30 pounds in six months is much too much! Is he obese? That would certainly put him at risk of type 2 diabetes.

The glucose results you have obtained with the glucose meter at home certainly are concerning, but I am always a bit cautious when people check glucose readings with a meter when the “patient” has not been diagnosed with diabetes. Home glucose meters are not so accurate as to commonly allow one to establish a diagnosis of diabetes. The meter readings may be off by up to 20%. So, your values of 130 mg/dl [7.2 mmol/L] might really be more normal at 104 mg/dl [5.8 mmol/L] or really be more concerning at 156 mg/dl [8.7 mmol/L]. Also, if the meter has not been properly coded (as some require) or there is sub-optimal prepping of the skin before checking, the values may not be accurate. You may be doing everything perfectly.

Weight gain does not typically occur before treating type 1 diabetes, but it can be a clue to type 2 diabetes. Other illnesses, including rare things such as cortisol excess or metabolic syndrome can mimic what you are finding.

Please have your child undergo a complete history and physical examination. If you think that your regular doctor is not taking you seriously enough, you can always get a second opinion (although insurance companies do not always pay for this). But, go to a pediatric health care provider and ask them to allow enough time when you make an appointment. A “walk-in” appointment probably will not allow the doctor enough time for the complete assessment that you want.

Good luck and let us know what is learned.

DS